Brachytherapy After TURP

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Richard Whittington, MD, Associate Professor of Radiation Oncology at the University of Pennsylvania School of Medicine, responds:

When brachytherapy (seed implant) is performed, the seeds are inserted throughout the prostate gland. After the urologist does a TURP, there is not enough of the central portion of the prostate gland left to hold the seeds.

The TURP may also affect the urinary sphincter, so there is a much higher risk of incontinence with a prostatectomy performed after TURP. For this reason, most men who are diagnosed by a TURP will get external beam radiation. In fact, most urologists do not do a TURP when they suspect prostate cancer, so that more options are available later for therapy. The reason for the problem is that the prostate has a central zone that gets larger as you get older, and a peripheral zone that is the most common part of the prostate for cancer to be located. It is kind of like an orange with a thick peel. The central pulpy part is what gets larger as you get older. The rind is where the tumors arise. A TURP takes out the orange pulp but does not want to mess with the rind, as that means they are getting closer to other tissues that may be injured -- so a TURP is not a cancer operation.

I should also say that this is a subjective assessment. Some urologist do what is called a "channel TURP", where they just remove the center of the gland, but most do a complete TURP so they don't have to go back and do another one in 2 or 3 years, which can lead to a higher complication rate. After a channel TURP, there may be enough central zone left to do an implant, although with the simultaneous scarring from the TURP and from the radiation, the complication rate is high. I have done a number of implants 5-10 years after TURP in cases where there has been some central regrowth. The acute irritation is worse, but the long-term effects on voiding and the rectum are not increased.

Oct 11, 2010 - Radical prostatectomy, external-beam
radiotherapy, and brachytherapy result in several quality-of-life issues after prostate cancer treatment in patients not receiving adjuvant hormonal treatment, including either improvement in or worsening of urinary irritative-obstructive symptoms in addition to the more commonly discussed sexual and incontinence issues, according to research published online Oct. 4 in the Journal of Clinical Oncology.